NIH tailors RTW program specifically for nurses
Clinical duty not out of the question
Nurses are among the highest risk professions for back injury, and when a nurse is injured, devising their return to work in an environment that demands physical tasks — lifting patients, pushing gurneys, etc. — can be a challenge. Add to the fact that not only are nurses at high risk for musculoskeletal injury, lots of them actually do get injured. In fact, OSHA estimates that nearly half of all health care workers, including nurses, will experience at least one work-related musculoskeletal disorder during their working lives.
"Getting nurses back to work is particularly difficult because of the work nurses do," says Pamela Koviack, RN, nursing consultant for the National Institute of Health’s (NIH) Warren Grant Magnuson Clinical Center (Clinical Center), the NIH’s clinical research facility in Bethesda, MD. "It’s difficult to place them back into direct care."
But a program that she helped get off the ground in 1999 — when she herself was an endoscopic nurse on light duty from an injury — is getting nurses back to work, even back into direct patient care roles. "We put the program in place to ensure we were using consistent practices in handling staff who have functional limitations," says Koviack, who now serves as coordinator of the medical and reasonable accommodation program (MRAP).
The program was developed with input from the NIH’s office of workers’ compensation, the Equal Employment Opportunity office, legal counsel, human resources, employee assistance representatives, and occupational medical services, all of whom made up a task force "to see what we could do better" when one of the clinical center’s 660 nurses is injured, she says.
"When you realize that the average age of a nurse in the U.S. is 46, you realize that because of our age and the type of work we do, we’re susceptible to injury," she says. Those injuries can occur on or off the job, so the MRAP at the Clinical Center does not discriminate based on where the injury occurred.
"We will accommodate anyone, so long as their limitations are not so severe that they can’t do work," she says.
Start with an assessment
When an injured nurse is ready to return to work, the first step is to have the nurse complete a self-reporting assessment of his or her limitations. That report, backed up by documentation from the nurse’s physician, is followed by a skills checklist that the nurse fills out, indicating what work he or she is comfortable doing. "Computer programs, interviewing patients — we have a large skills checklist, and we match those skills and functions against the jobs we need to have done," Koviack explains. (See checklist)
The program is part of the Clinical Center’s Nursing and Patient Care Services Department, but other departments are called on to fill their vacancies with limited-duty nurses.
"We can support other departments, such as research physicians who need assistance with research projects, or radiology, who needs them to monitor patients," Koviack says. "They may be out of the direct care arena, but still they are supplying needed resources in other areas of the clinic."
Limited duty assignments are maintained and assigned by the hospital’s central staffing department. Departments or administrators with the need for help or with absent staff are matched with the available limited-duty nurses.
At any one time, there are usually six to eight people in the MRAP program, Koviack reports.
When a member of the nursing staff requires accommodation for an injury or illness, the nurse requests entry into the program through his or her supervisor. The supervisor of record remains the employee’s supervisor. The employee’s schedule usually is changed to a Monday through Friday day shift unless the temporary work assignment requires rotation to other shifts.
Finding a fit
The MRAP can accommodate a nurse for about six months, says Koviack. At that point, she meets with the employee to assess where they go from there. "We get a prognosis for their return to full duty," she says. "In the rare case they might never be able to go back to their routine direct care responsibilities — and that happens rarely, thank goodness. [When it does], we will help by circulating their resume. [NIH] is a big organization, and we are usually able to find a good fit quickly."
Nurses on MRAP limited duty reassignment remain at their regular pay level and reap the much-proven benefits of returning to work sooner, rather than later. "We value their abilities, and just because they can’t work at a patient’s bedside doesn’t mean they can’t support the organization," she says. "If they’re home on workers’ comp, we’re paying them anyway. This way, they’re filling jobs we need to have done, and that saves the organization from having to hire temp help.
"Plus, it benefits the employees by not making them use up their sick leave, keeping them gainfully employed, still covering their insurance. And statistics show that when you get an employee back to work sooner, they come back to full duty much quicker."
She says she finds that rather than take advantage of the break from the heavy-duty routine work of patient care, most nurses in the program are anxious to return to full duty. Sixty percent of nurses who enter the program are in it for fewer than 30 days. "I haven’t found any malingering problem, or people wanting to stay in limited capacity so they don’t have to work so hard," she says. "People are nurses because they like what they do."
Participants’ feedback tailors program
Feedback from participants in the MRAP has been used to tailor the program over its five years in operation, and one of the biggest changes has been to allow some nurses in the program to work modified clinical assignments. "Employees were asking to go to direct patient care, and before, we did not put them where they could incur further injury," she says. "But we looked into it and found that possibly a modified clinical assignment would work for some nurses, and we have made that change."
Nurses on modified clinical duty might find themselves taking vital signs, doing admissions and patient interviews, administering medicines, and starting IVs.
Koviack says the MRAP program in the nursing services division has led other departments to pattern similar programs. "There is a need for this no matter what department you’re in — dietary, housekeeping, whatever. Other departments have been doing it, but I think we’re just more systematic about keeping the data and being consistent for fairness and EEO purposes," she points out.
Since Clinical Center’s MRAP was launched, nurses in the program have filled 25,382 hours, or 3,171 eight-hour shifts, in temporary work assignments. Koviack says her department’s research shows that using accommodated staff to fulfill the needs of the nursing services department potentially saved the center $731,763 in the first three years of the program in potential overtime and agency expenses.
Of the 147 staff who were accommodated during the first three years of the program, 61 employees were enrolled due to work-related injury. Allowing them to continue to work in an accommodated status saved the organization an estimated $270,000 in workers’ compensation claims.
The MRAP program seeks to place every qualified employee seeking accommodated assignments, but placement is not guaranteed. When an assignment match cannot be made, the employee still can request sick leave, leave without pay, or other disability leave options available at the Clinical Center.
For more information, contact:
- Pamela Koviack, RN, Coordinator, Nursing and Patient Care Services Medical and Reasonable Accommodation Program, Bethesda, MD. Phone: (301) 496-5507. E-mail: [email protected].
Nurses are among the highest risk professions for back injury, and when a nurse is injured, devising their return to work in an environment that demands physical tasks lifting patients, pushing gurneys, etc. can be a challenge.
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